Frequency of massive diphenhydramine ingestions in children 6-18 years of age

Intentional diphenhydramine ingestions increased in 2020 due to the Coronavirus pandemic and social media challenges. The purpose was to describe trends in frequency, management, and outcomes of massive (≥2,500 mg) and non-massive diphenhydramine ingestions in children from 2016-2023, which are prior to and after the COVID-19 and the TikTok^® "Benadryl Challenge."

This retrospective time-series utilized the National Poison Data System (NPDS)^® records of diphenhydramine ingestions in patients 6-18 years of age between January 1, 2016-December 31, 2023. The primary objective was to evaluate the frequency of massive and non-massive diphenhydramine ingestions. Secondary objectives included comparison of frequency of diphenhydramine ingestions in 2016-2019 to 2020-2023, and comparison of outcomes and management of massive and non-massive ingestions. Bivariate comparisons were made using Chi-Square or Fisher's Exact tests, and interrupted time-series analysis and segmented linear regression models to compare rates of diphenhydramine ingestions between time periods.

There were 24,358 cases, with a 34.3% increase from 2016-2019 to 2020-2025. Of those, 1,190 cases (4.9%) were classified as massive ingestions. Massive ingestions increased from 4.6% to 5.1% of cases from 2016-2019 and 2020-2023, respectively, with an estimated quarterly change of 0.03% (95% CI: -0.01-0.06%). Inpatient admission was required in 69.6% and 26.2% of massive and non-massive ingestions, respectively (P <0.001). Massive ingestion resulted in major effects (i.e.,, life-threatening symptoms or residual disability or death) in 21.3% and 1.0% of cases, respectively, resulting in greater use of mechanical ventilation, pharmacologic therapies, and gastrointestinal decontamination.

Diphenhydramine ingestions increased from 2016-2023, but the percentage of massive ingestions was not statistically different prior to and after 2020. Management is variable, with a greater percentage of massive ingestion cases requiring inpatient admission and receiving pharmacologic treatment.

The percentage of massive diphenhydramine ingestions ranged from 2.7-6.7% of reported ingestions from 2016-2023, and the trend since 2020 was not significantly increased. Massive diphenhydramine ingestions are associated with more severe symptoms and higher levels of care.